ChatForum – Gout

ChatForum – Gout

July 22, 2013 – Having Gout Attack, Don’t Know Where to Turn. A reader wrote in to ask: “I have recently been diagnosed with gout and have been having an attack for some time. I have since diagnosis cut out alcohol and following all the diet advice i been given. Currently taking NSAIDS as prescribed and colchimax but not making any difference. Even 50mg Tramadol not easing the pain. I dont know where to turn too? Any advice please?”

Dr. Richard Brasington, Director of Clinical Rheumatology and Professor of Medicine at Washington University, was kind enough to comment on this question. If you are having a gout attack, he says, then you need to use large doses of non-steroidal drugs or NSAIDS (Ibuprofen, Alleve, etc.). “Colchicine only works at the beginning of an attack, and if you don’t take it at the beginning, then it’s not going to work. Tramadol has no anti-inflammatory effect; it is just a pain reliever. You really have to treat the inflammation; if you don’t make that better, then the pain medicine won’t work.”

It’s important to control inflammation and do it as soon as possible, Dr. Brasington says. Then you can usually take less medicine. If you wait until the gout is established, you’ll likely have to take a larger amount of medicine for a longer time.

“That’s really important, to treat it immediately,” he says. “If you know you have gout, you don’t ever want to go anywhere without gout medicine and don’t EVER want to delay about treating it”

There are really only three kinds of medicine for an acute gout attack, he says: colchicines, non-inflammatory steroidals and prednisone. “The attack will go away on its own eventually, but most people don’t want to suffer through that.”

June 18, 2013 – A not-infrequent complaint from gout sufferers on Web sites and Facebook pages is, essentially, “I’ve tried everything, I’m even on medication, and it’s not getting better. What should I do?” Fact is, it’s not the uric acid that hurts but the uric acid crystals, and it takes a while for the medication to deal with that. Here’s the story on that from Dr. Theodore Fields, Professor of Clinical Medicine at Weil-Cornell MedicalCollege: “People need to know that in the early stages of treatment with medication to lower uric acid they can still get attacks. It may take 6 months, or sometimes a year or more, to get things under control. Gout is due to crystals in the joints, not just the blood level of uric acid. Thus, even through medication can get the uric acid below 6 within weeks, it can take a long time to gradually remove the crystals from the joints. For this reason, patients starting medications to lower their uric acid should plan with their doctor in advance what to do if an attack comes. Also, in addition to the uric-acid-lowering drug, people should discuss with their doctor about taking a medication for the first 6 months, such as colchicine, that can help prevent those early gout flares.”

June 14, 2013 reader comment: In response to statistics on gout for people who are “obese,” “overweight” and “healthy weight,” Stepanie wrote in: “that’s really crazy because everyone i know with gout is not over weight. It could be the state I live in.”

Our June 14, 2013 reply: Stehanie, hmmm. Might depend on your definition of “overweight.” If you look at Dr. Choi’s figures, you see that almost half of people with gout are people who are “healthy weight” or people like me, who are “overweight.” People tell me, “What? You don’t look fat.” But I am “overweight.” The official definition “healthy weight” seems to me pretty darn skinny and, as a dieter, I find it hard to attain.

June 14, 2013 reader comment: Stephanie wrote: “I am new here and I’m mostly here for my bf. He seems to have all the symptoms of gout. He gets is particularly bad in his ankle all though he has had symptoms in his big toe and feet. His ankle however swells up really big. He can’t walk… he just hobbles and it hurts him terribly… I am sure he needs to drink more water and avoid certain foods. I really want to help him. Any suggestions on diet or lifestyle would really be appreciated J”

Our June 14, 2013 reply: Yow, Stephanie, sounds bad. I think he needs to get diagnosed by a doc. A rheumatologist doc is recommended especially, by Dr. Fields. For one thing, he says ” it is a fallacy to consider gout a dietary disease. Gout is a genetic disease, he reminds us, which predisposes patients to get elevated uric acid in the blood and gouty inflammation in the joints. And patients without a genetic tendency to gout don’t get gout even if they eat all the “wrong foods.”

“Having said that, it is still possible for patients with gout to decrease their frequency of gout attacks by watching their diet, since diet can absolutely set off gout attacks,” he says. “We advise being as moderate as possible with red meat, shellfish, high-fructose corn syrup (as in regularly sweetened sodas) and alcohol, especially beer.”

PS, Stephanie, is your BF taking medication? Dr. Fields also says: “…studies have shown that even the absolutely lowest purine diet, which is lower than most any patient can eat outside of an experimental setting, will only lower the uric acid by 1 mg/dL, and we need to get gout patients’ uric acid less than 6 mg/dL,” he says. “If patients are starting out at a uric acid of 7 mg/dL or more, it is extraordinarily unlikely that they can get their uric acid to ‘goal’ just with diet – they will need medication as well.” These comments are taken from Dr. Field’s advice in the articles in “Gout News & Tips,” which has links on this Facebook page. Specifically, they’re taken from the articles “Authoritative Gout Answers” and “When Your Gout Regiment Isn’t Working.”

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